Hennessy Speech and Drama Studio 2018 Enrolment and Payment Form
Postal and Studio Address: 17 Badgery Avenue, Homebush, NSW, 2140
Email address *
Student Name: *
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Home Address: *
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Date of Birth: *
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School Attended: *
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School Grade: *
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Term 2 dates
Enrolment day, time and location: *
PARENT / GUARDIAN INFORMATION
Mother's Full Name:
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Contact Ph / Mobile:
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Contact Email:
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Father's Full Name:
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Contact Ph / Mobile:
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Contact Email:
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In case of Emergency:
Name:
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Contact Ph / Mobile:
Your answer
Does your child have any medical condition / impairment / disability you feel we should be informed about:
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Does your child suffer from Asthma? *
Does your child have any food allergies or intolerances? *
If yes, please advise:
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Does your child have any other allergies? *
If yes, please advise:
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IN CASE OF EMERGENCY, I give The Hennessy Speech and Drama Studio permission to call an ambulance and understand I must meet any costs incurred. I am aware that Kidz on Stage will make every effort to contact me or an emergency contact as listed on this form. *
I give permission for photographs of my child or video footage, taken in class, to be used in promotions, advertisements and information packages (eg. On our website, for newspaper advertisements and on promotional fliers). *
PAYMENT OPTIONS accepted: *
To pay by credit card - click on the link below or cut and paste the link below into your url
Nb: If you are paying using the trybooking link above, please be aware this will open up in a new window and you will need to return to this online application form to continue with your application.
Fee amount Enclosed: *
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